Provider Demographics
NPI:1841573763
Name:HENDERSON, KRISTY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7308
Mailing Address - Country:US
Mailing Address - Phone:302-738-6333
Mailing Address - Fax:302-224-3168
Practice Address - Street 1:124 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7308
Practice Address - Country:US
Practice Address - Phone:302-738-6333
Practice Address - Fax:302-224-3168
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA10003941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist